NSG 124 Final Exam Actual Exam V1 | NSG 124 Pharmacology
(NSG124 Final Exam) | Herzing University PDF
1. A patient is prescribed a medication that has a high first-pass effect. Which route of
administration should the nurse expect to be avoided to ensure maximum bioavailability?
A. Intravenous
B. Sublingual
C. Oral
D. Transdermal
Answer: C
Rationale: The first-pass effect occurs when a drug is metabolized in the liver before it
reaches the systemic circulation, which primarily affects drugs taken orally. By using other
routes like intravenous or sublingual, the drug bypasses the liver initially, maintaining a
higher concentration in the blood. The nurse must understand that oral doses of such drugs
are often much higher than parenteral doses to compensate for this metabolism.
2. A nurse is caring for a client with a serum creatinine level of 2.5 mg/dL. Which
pharmacokinetic phase is most likely to be impaired in this patient?
A. Absorption
B. Excretion
C. Metabolism
D. Distribution
Answer: B
Rationale: Creatinine is a marker of kidney function, and an elevated level indicates renal
impairment, which directly affects the excretion phase of pharmacokinetics. When
excretion is impaired, drugs can accumulate to toxic levels in the body. The nurse should
anticipate dosage adjustments or increased monitoring for adverse effects in patients with
renal insufficiency.
3. A physician orders 250 mg of a medication. The pharmacy provides the medication in 125
mg tablets. How many tablets should the nurse administer?
A. 0.5 tablet
B. 1 tablet
C. 1.5 tablets
D. 2 tablets
,Answer: D
Rationale: The calculation is performed by dividing the desired dose (250 mg) by the dose
on hand (125 mg), resulting in 2 tablets. This basic dosage calculation is essential for
ensuring patient safety and preventing medication errors. The nurse should always verify
the calculation twice before administration to maintain accuracy.
4. A nurse is preparing to administer Digoxin to a patient. Which assessment finding would
require the nurse to hold the medication and notify the provider?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Temperature of 98.6°F
Answer: C
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, it is standard
nursing practice to hold the dose if the apical pulse is below 60 beats per minute.
Bradycardia is a common sign of digoxin toxicity, which can be life-threatening if ignored.
The nurse must perform a full one-minute apical pulse check before administering this
specific medication.
5. A patient taking Lisinopril for hypertension develops a dry, persistent cough. What is the
nurse’s best action?
A. Advise the patient to take an over-the-counter cough suppressant.
B. Notify the provider as this may require a change in medication.
C. Explain that this is a common side effect and will resolve in two days.
D. Instruct the patient to increase fluid intake to loosen secretions.
Answer: B
Rationale: A dry cough is a well-known adverse effect of ACE inhibitors like Lisinopril due
to the accumulation of bradykinin in the lungs. This side effect often leads to non-
compliance, so the provider usually switches the patient to an Angiotensin II Receptor
Blocker (ARB). The nurse’s role is to identify this drug-linked symptom and facilitate a
pharmacological alternative for the patient.
6. Which of the following instructions should the nurse include for a patient starting
Furosemide?
A. Change positions slowly to prevent dizziness.
B. Take the medication immediately before bedtime.
C. Consume a diet low in potassium-rich foods.
, D. Restrict fluid intake to 500 mL per day.
Answer: A
Rationale: Furosemide is a potent loop diuretic that can cause orthostatic hypotension due
to rapid fluid loss. Patients should be taught to change positions slowly to prevent falls and
injury related to dizziness. Additionally, because it is a potassium-wasting diuretic, patients
are usually encouraged to increase, not decrease, their potassium intake.
7. A client is receiving Spironolactone. Which laboratory value should the nurse monitor most
closely?
A. Serum Sodium
B. Serum Potassium
C. Serum Glucose
D. Serum Calcium
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits aldosterone,
leading to the retention of potassium. Hyperkalemia is a significant risk with this
medication, especially if the patient has renal impairment or takes potassium supplements.
The nurse must monitor for signs of high potassium, such as cardiac arrhythmias or muscle
weakness.
8. A nurse is teaching a patient about the use of Sublingual Nitroglycerin for chest pain.
Which statement by the patient indicates a need for further teaching?
A. I should swallow the tablet with a full glass of water.
B. I can take up to three tablets, five minutes apart.
C. I will store the tablets in their original dark glass bottle.
D. I will sit down before taking the medication.
Answer: A
Rationale: Sublingual nitroglycerin must be dissolved under the tongue to be absorbed
directly into the systemic circulation; swallowing it would lead to the first-pass effect and
render it ineffective. Sitting down is necessary because the drug causes rapid vasodilation
and can lead to syncope. The dark bottle is required to protect the medication from light-
induced degradation.
9. A patient is prescribed Warfarin. Which of the following should the nurse instruct the
patient to keep consistent in their diet?
A. Green leafy vegetables
B. Dairy products
(NSG124 Final Exam) | Herzing University PDF
1. A patient is prescribed a medication that has a high first-pass effect. Which route of
administration should the nurse expect to be avoided to ensure maximum bioavailability?
A. Intravenous
B. Sublingual
C. Oral
D. Transdermal
Answer: C
Rationale: The first-pass effect occurs when a drug is metabolized in the liver before it
reaches the systemic circulation, which primarily affects drugs taken orally. By using other
routes like intravenous or sublingual, the drug bypasses the liver initially, maintaining a
higher concentration in the blood. The nurse must understand that oral doses of such drugs
are often much higher than parenteral doses to compensate for this metabolism.
2. A nurse is caring for a client with a serum creatinine level of 2.5 mg/dL. Which
pharmacokinetic phase is most likely to be impaired in this patient?
A. Absorption
B. Excretion
C. Metabolism
D. Distribution
Answer: B
Rationale: Creatinine is a marker of kidney function, and an elevated level indicates renal
impairment, which directly affects the excretion phase of pharmacokinetics. When
excretion is impaired, drugs can accumulate to toxic levels in the body. The nurse should
anticipate dosage adjustments or increased monitoring for adverse effects in patients with
renal insufficiency.
3. A physician orders 250 mg of a medication. The pharmacy provides the medication in 125
mg tablets. How many tablets should the nurse administer?
A. 0.5 tablet
B. 1 tablet
C. 1.5 tablets
D. 2 tablets
,Answer: D
Rationale: The calculation is performed by dividing the desired dose (250 mg) by the dose
on hand (125 mg), resulting in 2 tablets. This basic dosage calculation is essential for
ensuring patient safety and preventing medication errors. The nurse should always verify
the calculation twice before administration to maintain accuracy.
4. A nurse is preparing to administer Digoxin to a patient. Which assessment finding would
require the nurse to hold the medication and notify the provider?
A. Blood pressure of 110/70 mmHg
B. Respiratory rate of 18 breaths per minute
C. Apical pulse of 52 beats per minute
D. Temperature of 98.6°F
Answer: C
Rationale: Digoxin is a cardiac glycoside that slows the heart rate; therefore, it is standard
nursing practice to hold the dose if the apical pulse is below 60 beats per minute.
Bradycardia is a common sign of digoxin toxicity, which can be life-threatening if ignored.
The nurse must perform a full one-minute apical pulse check before administering this
specific medication.
5. A patient taking Lisinopril for hypertension develops a dry, persistent cough. What is the
nurse’s best action?
A. Advise the patient to take an over-the-counter cough suppressant.
B. Notify the provider as this may require a change in medication.
C. Explain that this is a common side effect and will resolve in two days.
D. Instruct the patient to increase fluid intake to loosen secretions.
Answer: B
Rationale: A dry cough is a well-known adverse effect of ACE inhibitors like Lisinopril due
to the accumulation of bradykinin in the lungs. This side effect often leads to non-
compliance, so the provider usually switches the patient to an Angiotensin II Receptor
Blocker (ARB). The nurse’s role is to identify this drug-linked symptom and facilitate a
pharmacological alternative for the patient.
6. Which of the following instructions should the nurse include for a patient starting
Furosemide?
A. Change positions slowly to prevent dizziness.
B. Take the medication immediately before bedtime.
C. Consume a diet low in potassium-rich foods.
, D. Restrict fluid intake to 500 mL per day.
Answer: A
Rationale: Furosemide is a potent loop diuretic that can cause orthostatic hypotension due
to rapid fluid loss. Patients should be taught to change positions slowly to prevent falls and
injury related to dizziness. Additionally, because it is a potassium-wasting diuretic, patients
are usually encouraged to increase, not decrease, their potassium intake.
7. A client is receiving Spironolactone. Which laboratory value should the nurse monitor most
closely?
A. Serum Sodium
B. Serum Potassium
C. Serum Glucose
D. Serum Calcium
Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic that inhibits aldosterone,
leading to the retention of potassium. Hyperkalemia is a significant risk with this
medication, especially if the patient has renal impairment or takes potassium supplements.
The nurse must monitor for signs of high potassium, such as cardiac arrhythmias or muscle
weakness.
8. A nurse is teaching a patient about the use of Sublingual Nitroglycerin for chest pain.
Which statement by the patient indicates a need for further teaching?
A. I should swallow the tablet with a full glass of water.
B. I can take up to three tablets, five minutes apart.
C. I will store the tablets in their original dark glass bottle.
D. I will sit down before taking the medication.
Answer: A
Rationale: Sublingual nitroglycerin must be dissolved under the tongue to be absorbed
directly into the systemic circulation; swallowing it would lead to the first-pass effect and
render it ineffective. Sitting down is necessary because the drug causes rapid vasodilation
and can lead to syncope. The dark bottle is required to protect the medication from light-
induced degradation.
9. A patient is prescribed Warfarin. Which of the following should the nurse instruct the
patient to keep consistent in their diet?
A. Green leafy vegetables
B. Dairy products
